I got a very upsetting call today letting me know that Jordan's surgery authorization was denied and her surgery has been cancelled. They will not keep us on the books to reserve the spot until it is worked out. I was told by our case manager that everything was fine and today I find out that the new medical director of Monarch and our new case manager (our last one left on maternity leave) decided that it isn't necessary for us to be out of network at UCLA when there is a provider in network who can provide the services. We have already discussed with Monarch our lack of confidence in the surgeons in network (one pediatric orthopaedic office for all of Orange County). That was the reason the past medical director allowed us to leave Network. They allowed us our office visit and let us schedule the surgery and then denied the authrization.
All this to say that if you would please pray for us I would really apprecite it.
1. That I/we would be content with whatever date/time God has set for Jordan's surgeries this year.
2. That Dr. Oppenheim (his secretary) would hold our surgery date for a few days or a week until I can get someone to call me back to find out more details and petition them by phone.
3. That Dr. Oppenheim, who is on vacation, would email me with a note saying that it is medically necessary that this issue is expedited and also stating the fact that the surgery should have been done months and months ago (further demonstrating reason for our lack of confidence in the old doctor who didn't see it or mention it to us).
4. That I would be diligent in getting the appeal process started (a GIANT headache - we've been through this before and they make it SO difficult and it takes so long that no one can really outlast them).
5. That if could be God's will that this can be resolved tomorrow when our case manager calls me back - that it is simply an oversight on their part in not realizing the history with our past doctor and the reasons permission was granted for us to go to UCLA.
6. That an appeals process wouldn't have to take place - What if we are forced to go back to them and they know that we don't trust them and don't want to be there? An appeal would mean involving our insurance company's quality assurance department and they would go to the office to investigate the files etc. It would be uncomfortable and awful to have to go back there again. Pray it doesn't get to this point.
7. Wisdom and patience, waiting on God's timing and trusting that He is over all of this and already knows the outcome.
Thanks - I'll post more tomorrow.